Kim Hee Jung, Park Sung Jun, Koo Hyun Jung, Kang Joon-Won, Yang Dong Hyun, Jung Sung-Ho, Choo Suk Jung, Chung Cheol Hyun, Lee Jae Won, Kim Joon Bum
Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Thorac Dis. 2020 May;12(5):1942-1951. doi: 10.21037/jtd-20-188.
Obtaining adequate effective orifice area (EOA) in surgical aortic valve replacement (SAVR) is important to minimize pressure gradients across the prosthetic aortic valve (AV) and improve clinical outcomes. However, the predictors of EOA are unclear.
From July 2011 to March 2016, patients undergoing SAVR who were preoperatively evaluated using a computed tomography (CT) on the aortic root were enrolled. Indexed EOA (iEOA) was used as an indicator of prosthetic AV opening area. The aortic root parameters investigated were the annular diameter (max and min), annular perimeter, annular area, and maximal dimensions of the proximal ascending aorta. These variables were evaluated as predictors of EOA, and an individual surgeon was incorporated in analysis for verifying surgeon dependent factors.
Among the 710 patients included in this study [age: 64.9±10.8 years; females: n=285 (40.1%)], 370 (52.1%) were implanted with bio-prosthesis. Mean prosthetic iEOA was 1.1±0.3 cm/m. Univariable linear regression analysis showed that all indexed aortic root parameters (maximal and minimal annular diameters, annular perimeter, annular area, and sinus dimensions) were significantly associated with iEOA (P<0.001). Multivariable analysis showed that indexed aortic annular area, indexed maximal diameter of the Valsalva sinus, female sex, and bio-prosthesis, supra-annular type prosthesis and surgeon were significant and independent determinants of iEOA (adjusted R=0.513, P<0.001).
Aortic annular area and Valsalva sinus diameter are independent determinants for iEOA measured by preoperative CT; surgeon-dependent factors are also significant determinants in SAVR.
在外科主动脉瓣置换术（SAVR）中获得足够的有效瓣口面积（EOA）对于最小化人工主动脉瓣（AV）上的压力梯度并改善临床结果很重要。然而，EOA的预测因素尚不清楚。
纳入2011年7月至2016年3月期间接受SAVR且术前对主动脉根部进行计算机断层扫描（CT）评估的患者。将指数化EOA（iEOA）用作人工AV开口面积的指标。研究的主动脉根部参数包括环直径（最大和最小）、环周长、环面积以及升主动脉近端的最大尺寸。将这些变量作为EOA的预测因素进行评估，并纳入一名个体外科医生进行分析以验证与外科医生相关的因素。
在本研究纳入的710例患者中[年龄：64.9±10.8岁；女性：n = 285例（40.1%）]，370例（52.1%）植入了生物假体。人工iEOA的平均值为1.1±0.3 cm/m²。单变量线性回归分析表明，所有指数化的主动脉根部参数（最大和最小环直径、环周长、环面积以及窦部尺寸）均与iEOA显著相关（P<0.001）。多变量分析表明，指数化的主动脉环面积、指数化的主动脉窦最大直径、女性性别、生物假体、瓣上型假体和外科医生是iEOA的显著且独立的决定因素（调整R² = 0.513，P<0.001）。
主动脉环面积和主动脉窦直径是术前CT测量iEOA的独立决定因素；在SAVR中，与外科医生相关的因素也是重要的决定因素。
